Objective To evaluate the anti-tussive effect of a total alkaloid agent extracted from Papaver Somniferum L. on simple chronic bronchitis of which the syndrome was counterflow ascent of lung qi according to traditional Chinese medicine (TCM). Methods Randomised, double blind method, placebo control and add on design were applied. Forty-five patients with counterflow ascent of lung qi of simple chronic bronchitis were randomly divided into two groups: treatment group (n=21) with alkaloid agent and control group (n=24) with placebo. Results The incidences of obvious coughing in treatment and control groups were 66.67% and 70.83% (P=0.763 3) respectively. The cough alleviation time of patients was 14.64±16.30 h and 15.12±15.28 h (P=0.795 6) respectively. The loss of cough rates on the third day was 28.57%, 16.67% (P=0.337 7) respectively. The average scores decreased were 4.29 and 2.88 (P=0.054 8) respectively. Conclusions The study indicates that total alkaloid agent extracted from Papaver somniferum L. has no significant anti-tussive effect on patients with counterflow ascent of lung qi of simple chronic bronchitis treated with cefaclor sustained release capsules simultaneously. The trial was interrupted by the advice from experts who disagreed with the selection of drug indication.
Objective To improve the precision of subsegmentectomy, through analyzing the proportion and classification of the intrasegmental and intersegmental trans-subsegmental artery (TSA) in the right upper lobe. Methods The imaging data of the patients who underwent pulmonary angiography in the right upper lobe from January 2021 to June 2022 at the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The anatomy of subsegmental bronchi and arteries in the right upper lung was studied by comparing 3D CT bronchography and angiography and thin-section CT (lung window). The types of tans-subsegmental artery were further refined. Results Finally 111 patients were collected, including 36 males and 75 females with an average age of 61.83±8.91 years. There were 29 types of TSA in the right upper pulmonary artery, and 45% (13/29) of the types occurred only once. In the S1, S2, and S3 segments, the proportion of TSA was 52% (58/111), 41% (45/111), and 32% (36/111), respectively. Among them, the type with the highest proportion was A1b+A1at in S1, originating from the upper trunk artery, accounting for 67% (39/58). There were 24% (27/111), 5% (5/111), and 8% (9/111) TSA between S1 and S2, S2 and S3, and S1 and S3, respectively. There were four types of bronchi in the right upper lobe. There was no statistical difference in the proportion of the intrasegmental and intersegmental TSA (P>0.05). Conclusion The TSA in the right upper lobe is common and has various types. Segmentectomy or subsegmentectomy is a highly personalized surgical procedure.
Abstract： Objective To introduce the new procedure of endobronchial ultrasoundguided transbronchial needle aspiration (EBUSTBNA) for staging lung cancer and diagnosing thoracic diseases, in order to determine its value in the evaluation of thoracic diseases. Methods We retrospectively reviewed the data of all patients examined with EBUSTBNA our institution between September 2009 and May 2010. Among the patients, there were 75 males and 31 females with an average age of 62.3 years old. Based on their primary indication, we divided all the 106 patients into three categories. (1) There were 76 patients with known or bly suspected lung cancer. Enlarged mediastinal lymph nodes on radiographic examination of the chest (≥1.0 cm) were detected in all the patients. (2) There were 22 patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin. (3) There were 8 patients with pulmonary mass located close to the central airways. Results (1) 76 patients underwent EBUSTBNA for known or bly suspected lung cancer. Among them, 58 patients were confirmed to have mediastinal lymph nodes metastasis on EBUSTBNA. Sixteen in the 18 patients with negative EBUSTBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection. Postoperative pathology confirmed that 12 patients did not have metastatic nodes, 2 patients had metastatic nodes and 2 other patients had benign lesions within the lung. The diagnostic sensitivity, specificity and accuracy of EBUSTBNA for the mediastinal staging of lung cancer were 96.66%(58/60), 100.00%(12/12) and 97.22%(70/72), respectively. (2) 22 patients underwent EBUSTBNA for the evaluation of mediastinal adenopathy or mass in the absence of any identifiable pulmonary lesion. Among them, 7 had malignancy, 13 had benign diseases on EBUSTBNA and the sensitivity of EBUSTBNA in distinguishing malignant mediastinal diseases was 87.50% (7/8). (3) 8 patients with pulmonary mass located close to the central airways were accessed by EBUSTBNA. Definite diagnosis was achieved in 7 patients, and lung cancer was detected in 6 patients. The sensitivity and the diagnostic accuracy of EBUSTBNA for the diagnosis of unknown pulmonary mass was 85.71%(6/7) and 87.50%(7/8), respectively. All the procedures were uneventful, and there were no complications. Conclusion EBUSTBNA is a highly effective and safe procedure. We believe that EBUSTBNA should be used routinely in the diagnosis and staging of thoracic diseases.
Objective To evaluate and select essential medicine for acute bronchitis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Eight guidelines were included (seven foreign guidelines, one domestic guideline; five based on evidence, three based on expert consensus). (2) A result of six RCTs (n=816, low quality) indicated that pentoxyverine had efficiencies of 53% to 82% for cough relief. Among the six RCTs, a result of three RCTs (n=283) indicated that pentoxyverine was slightly less efficient than procaterol (RR=0.86, 95%CI 0.78 to 0.94, P=0.001); a result of two RCTs (n=233) indicated that pentoxyverine was slightly less efficient than Chinese medicinals decoction (RR=0.82, 95%CI 0.74 to 0.91, Plt;0.001). Adverse reaction of pentoxyverine (incidence: 0% to 2.4%) mainly covered nausea, palpitation, etc. Pentoxyverine cost 0.20 yuan (for adult) or 0.08 yuan (for child) daily, which was orally taken and applicable to the target population. (3) A result of six RCTs (n=403, low quality) indicated that the efficiencies of dextromethorphan for cough relief was 47.0% to 95.3%. Among the six RCTs, a result of one RCT (n=283) indicated that dextromethorphan hydrobromide (nasal drop) was more efficient than blank intervention (RR=3.71, 95%CI 1.91 to 7.21); a result of one RCT (n=43) indicated that dextromethorphan (for oral use) was more efficient than placebo (RR=1.74, 95%CI 1.13 to 2.66); a result of one RCT (n=300, moderate quality) indicated that dextromethorphan was more efficient than pentoxyverine (RR=1.16, 95%CI 1.07 to 1.26); a result of one observational study (n=121, low quality) indicated that dextromethorphan given for 5 days had an efficiency of 66.5%. Adverse reaction of dextromethorphan (incidence: 2% to 30%) mainly covered mouth dryness, dizziness, nausea, etc. Conclusion (1) We offer a b recommendation for dextromethorphan used in relieving dry cough due to acute bronchitis. (2) We offer a weak recommendation for pentoxyverine as symptomatic treatment for cough relief. (3) We make a recommendation against antibiotics, β2-agonist bronchodilators and mucolytic agents as routine use. (4) More large-scale, multi-center, double-blinded RCTs are needed in clinical and pharmacoeconomic studies of acute bronchitis in hopes of producing high-quality local evidence.
Objective To investigate the causal relationship between 91 circulating inflammatory proteins and respiratory tract infection by bidirectional Mendelian randomization. Methods single nucleotide polymorphisms (SNPs) for 91 inflammatory circulating proteins were derived from GWAS data from a genome-wide association study of 14 824 subjects of European ancestry on the Olink Target platform, and SNPs for acute bronchitis, acute bronchiolitis, and acute laryngitis and tracheitis were derived from GWAS pooled data in the FinnGen database. Inverse variance weighting method was used as the main research method to conduct bidirectional Mendelian randomization analysis, and Cochran’ IVW Q test, MR-Egger regression method and one by one elimination method were used to conduct sensitivity tests to evaluate heterogeneity and horizontal pleiotropy. In order to reduce the incidence of Class I errors and improve the feasibility of the study, Bonferroni correction was performed.ResultsLevels of C hemokine C-X-C motif ligand 6 (CXCL6), matrix metalloproteinase-1 (MMP-1), hepatocyte growth factor (HGF), interleukin-10 (IL-10), chemokine C-X3-C motif ligand 1 (CX3CL1), and TNF-related activation-induced cytokine (TRANCE) were causally associated with acute bronchitis. MMP-1 level [OR: 1.239 0, 95%CI: 1.111 6-1.382 2, P<0.000 5] had a significant causal relationship with acute bronchitiss and played a promoting role. Levels of macrophage inflammatory protein-1α (MIP-1α), signaling lymphocyte activating molecules, and FMS-associated tyrosine kinase 3 ligand (FIt3L) were potentially causally associated with acute bronchiolitis. There was a potential causal relationship between C-X-C motif chemokine 5 (CXCL5), T cell surface glycoprotein CD6 subtype (CD6), fibroblast growth factor 19 (FGF-19), C-C motif chemokine 23 (CCL23), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor ligand superfamily member 12 (TNFSF12) levels and acute laryngitis and tracheitis. In reverse Mendelian randomization analysis, there were no positive results between acute bronchitis, acute bronchiolitis and 91 inflammatory factors. Acute laryngitis and tracheitis [OR: 1.076 3,95%CI: 1.012 9-1.143 7, P=0.017 6] were potentially causally associated with FGF-19 levels. Conclusions MMP-1 level have a significant causal relationship with acute bronchitis. The levels of other inflammatory factors such as CXCL6, HGF, MIP-1 alpha, FIt3L, CXCL5, FGF-19 are potentially causally associated with respiratory tract infections. MMP-1 may be an important target for the prediction or treatment of acute bronchitis.
Objective To compare the value of fractional exhaled nitric oxide ( FENO) measurement and leukotriene D4 bronchial provocation test ( LTD4-BPT) in diagnosis and evaluation of asthma. Methods 20 uncontrolled,22 partially controlled, 20 controlled asthmatics, and 21 normal subjects were enrolled in the study. Measurement of FENO was performed followed by LTD4-BPT. The distribution characteristics and relationship of both results were analyzed, and the diagnostic value was compared using receiver operation characteristic ( ROC) curve.Results FENO was above 25. 0ppb in 80. 7% of the asthmatics. The proportion of asthmatics with FENO between 26.0ppb and 49.0ppb was larger in the uncontrolled and partially controlled subjects than that in the controlled subjects. Both the median and interquartile range of cumulative dosage ( PD20FEV1-LTD4) were much higher in the controlled asthmatics as compared with the uncontrolled and partially controlled asthmatics. The area under the ROC curve ( AUC) for PD20FEV1-LTD4 [ AUC: 0.914, 95% CI: ( 0.855, 0.974) ] was larger than that of FENO [ AUC: 0.820, 95% CI: ( 0.718, 0.921) ] . Higher sensitivity ( 0.8570 vs. 0.8065) and specificity ( 0.9048 vs. 0.7619) were in favor of PD20 FEV1 -LTD4 ≤ 4.800 nmol as compared with FENO ≥ 26.0ppb being the positive threshold. Conclusion Compared with FENO measurement, LTD4-BPT has higher sensitivity and specificity and is of higher diagnostic value for asthma.
Objective To evaluate the safety and diagnostic yield of transbronchial lung biopsy ( TBLB) performed in mechanically ventilated patients. Methods TBLB was performed in 19 mechanically ventilated patients form January 2001 to September 2007 in the ICU of Guangzhou Institute of Respiratory Diseases. The results of clinical data were retrospectively analyzed. Results A total of 19 patients were analyzed[ 9 female, 10 male, with amean age of ( 57. 94 ±15. 00) years] . Specific diagnoses were made in 9 cases ( 47. 4% ) by TBLB. The diseases included pulmonary aspergillus pneumonia in 4 cases ( 21. 0% ) ,lung cancer in 2 cases ( 10. 5% ) , radioactive pneumonia in 1 case( 5. 3% ) , Goodpasture’s syndrome in1case( 5. 3% ) , pulmonary tuberculosis in 1 case ( 5. 3% ) . Ten cases ( 52. 6% ) were not able to establish confirmed diagnoses including pulmonary interstitial fibrosis in 6 cases( 31. 6% ) and lung tissue nonspecific changes in 4 cases( 21. 0% ) . The treatment was adjusted according to the results of TBLB in 10 patients( 52. 6% ) . Complications associated with this procedure included episodes of bronchial hemorrhage of ≥30 mL in 4 cases ( 21. 0% ) , transient oxygen desaturation in 11 cases ( 57. 9% ) , hypotension in 5 cases ( 26. 3% ) , and transient tachycardia in 1 case ( 5. 3% ) without death and pneumothorax. Conclusions TBLB can be performed safely and has a diagnostic value in mechanically ventilated patients. TBLB should be considered as a diagnostic procedure before open lung biopsy.
ObjectiveTo explore the diagnostic value of endobronchial ultrasonography with a guide sheath (EBUS-GS) for pulmonary fungal disease.MethodsAll patients were collected from January 2015 to December 2018. They were diagnosed with pulmonary fungal disease by tissue biopsy, body fluid or blood test, and without other diseases such as pneumonia, lung cancer, lung abscess, tuberculosis, or organizing pneumonia, etc. After clinical anti-fungal treatment, clinical symptoms were relieved, chest CT lesions were absorbed, laboratory-related checks were turned negative in these patients. All patients underwent bronchoscopy, bronchoalveolar lavage fluid/brush examination, and blood galactomannan antigen test/latex agglutination test. They were divided into an EBUS-GS group and a non-EBUS-GS group according to whether EBUS-GS check was performed. Non-parametric test was used to analyze the diagnostic value of EBUS-GS in pulmonary fungal diseases.ResultsFifty-one patients were included and 20 patients in the EBUS-GS group and 31 patients in the non-EBUS-GS group. The EBUS-GS group had a higher positive rate of pulmonary fungal disease. The diagnostic rates of the EBUS-GS group and the non-EBUS-GS group were statistically different (90.0% vs. 48.4%, P<0.05).ConclusionEBUS-GS can improve the diagnosis rate of pulmonary fungal disease and provides further evidence for a clear diagnosis.
Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.
ObjectivesTo systematically review the efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis.MethodsDatabases including PubMed, EMbase, The Cochrane Library, CBM, VIP, CNKI and WanFang Data were electronically searched from inception to August 2018 to collect randomized controlled trials (RCTs) on ciprofloxacin in the treatment of non-cystic fibrosis bronchiectasis. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 1 666 patients were included. The results of meta-analysis showed that: compared with control group, the ciprofloxacin more efficiently eradicate bacteria from sputum (RR=4.34, 95%CI 2.04 to 9.23, P=0.000 1), decrease risk of the exacerbations (RR=0.81, 95%CI 0.71 to 0.93, P=0.002) and the mean bacterial load (MD=–4.08, 95%CI –6.29 to –1.87, P=0.001). However, there were no significant differences between two groups in clinical efficiency and adverse events.ConclusionsThe current evidence shows that, ciprofloxacin can decrease the mean bacterial load and risk of the exacerbation, and more efficiently eradicate bacteria from sputum in non-cystic fibrosis bronchiectasis patients. Due to limited quality and quantity of the included studies, more studies are required to verify the conclusions.